Our Summary

This research paper is about a study that looked at the relationship between the number of specific types of surgeries a hospital performs and the survival rates of patients. The surgery in question is called a pancreaticoduodenectomy (PD), a complex procedure often used to treat pancreatic cancer.

The researchers reviewed 17 past studies involving hospitals that perform this surgery. They found that hospitals that do a high volume of these surgeries each year (25 or more) have a much lower rate of patient deaths after the surgery. Patients who had their surgeries in these high volume hospitals were 63% less likely to die in the hospital.

The study also found that it didn’t matter what the exact cutoff for a “high volume” hospital was, or where the hospital was located - the survival benefit still held. However, the study also suggested that future research should look at places where smaller hospitals have specialized equipment and training for this surgery, to see if this could also improve survival rates.

FAQs

  1. What is the pancreaticoduodenectomy (PD) procedure often used to treat?
  2. Do hospitals performing a high volume of PD surgeries have a better survival rate for patients?
  3. Does the location or exact cutoff for a “high volume” hospital affect the survival benefits of the PD surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about Whipple procedure is to choose a hospital that performs a high volume of pancreaticoduodenectomies (25 or more per year) to increase the likelihood of a successful outcome. This research suggests that hospitals with more experience in performing this complex surgery have lower rates of patient deaths. It is also important to discuss with your doctor about specialized equipment and training available at smaller hospitals to potentially improve survival rates.

Suitable For

Patients who are typically recommended for a Whipple procedure include those with:

  1. Pancreatic cancer
  2. Bile duct cancer
  3. Duodenal cancer
  4. Ampullary cancer
  5. Chronic pancreatitis
  6. Pancreatic neuroendocrine tumors

It is important for patients to undergo thorough evaluation and consultation with a multidisciplinary team of healthcare providers to determine if they are suitable candidates for the Whipple procedure. Factors such as overall health, stage of the disease, and potential risks and benefits of the surgery need to be carefully considered before recommending the procedure.

Timeline

Before the Whipple procedure:

  1. Patient is diagnosed with a condition that may require a Whipple procedure, such as pancreatic cancer.
  2. Patient undergoes imaging tests, blood tests, and possibly a biopsy to confirm the diagnosis.
  3. Patient consults with a surgeon to discuss the risks and benefits of the Whipple procedure.
  4. Patient may undergo chemotherapy or radiation therapy to shrink the tumor before surgery.

After the Whipple procedure:

  1. Patient undergoes the Whipple procedure, which involves removing part of the pancreas, small intestine, and other nearby organs.
  2. Patient stays in the hospital for 7-14 days to recover from the surgery.
  3. Patient may experience complications such as infection, bleeding, or leakage from the surgical site.
  4. Patient may need to follow a special diet and take medications to help with digestion after the surgery.
  5. Patient undergoes follow-up appointments and imaging tests to monitor for recurrence of the condition.

What to Ask Your Doctor

  1. How many pancreaticoduodenectomy (Whipple) procedures does the hospital perform each year?
  2. What is the hospital’s mortality rate for patients undergoing the Whipple procedure?
  3. Are there any specific criteria that determine a hospital’s designation as a “high volume” hospital for this procedure?
  4. What is the hospital’s experience and success rate with the Whipple procedure?
  5. Are there any specific factors or practices at the hospital that contribute to the lower mortality rates for patients undergoing the Whipple procedure?
  6. Are there any potential risks or complications associated with undergoing the Whipple procedure at this hospital?
  7. Are there any alternative treatment options or hospitals that specialize in the Whipple procedure that I should consider?
  8. How will my care be coordinated between different healthcare professionals before, during, and after the Whipple procedure at this hospital?
  9. What is the hospital’s follow-up care plan for patients who undergo the Whipple procedure?
  10. Are there any ongoing research or initiatives at the hospital aimed at improving outcomes for patients undergoing the Whipple procedure?

Reference

Authors: Kovoor JG, Ma N, Tivey DR, Vandepeer M, Jacobsen JHW, Scarfe A, Vreugdenburg TD, Stretton B, Edwards S, Babidge WJ, Anthony AA, Padbury RTA, Maddern GJ. Journal: ANZ J Surg. 2022 Jan;92(1-2):77-85. doi: 10.1111/ans.17293. Epub 2021 Oct 22. PMID: 34676647